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Interobserver Agreement in the Assessment of Components of Colposcopic Grading

From the ¹Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, Missouri; and ²Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.

OBJECTIVE: To estimate the reproducibility of the assessment of visual characteristics of cervical lesions used to judge lesion grade from colposcopy.

METHODS: Digitized cervical images from 862 women enrolled in the ASCUS-LSIL Triage Study were obtained after application of 5% acetic acid. Each image was later assessed online by two randomly assigned evaluators from a pool of 20 experienced colposcopists. Interobserver agreement beyond chance was assessed by kappa statistics.

RESULTS: Of 862 evaluable images with paired assessments, 607 were considered to have an acetowhite lesion by both evaluators, 171 by one, and 84 by neither. Kappa values (95% confidence intervals) for agreement were 0.22 (0.17–0.27) for color, 0.24 (0.18–0.30) for margins, 0.22 (0.16–0.29) for mosaicism, 0.17 (0.11–0.23) for punctation, 0.11 (0.00–0.22) for atypical vessels, and 0.26 (0.22–0.31) for modified Reid Index score.

CONCLUSION: Characteristics used to assign colposcopic grade are poorly reproducible when used to assess static cervical images from women with borderline cytology results.

LEVEL OF EVIDENCE: II

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